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Video instructions and help with filling out and completing Medicare provider claims

Instructions and Help about Medicare provider claims

All right well good afternoon everyone all right these mics work that's good thank you so much for joining us on a busy day in Washington for today's briefing on what's next for Medicare provider payments my name is Sarah - and I am president and CEO of the Alliance for health policy and for those who are not familiar with the Alliance we are a nonpartisan organization dedicated to advancing knowledge and understanding of health policy issues so we're really glad you're here and hello as well to those who might be on Twitter at the hashtag all health live and you all can feel free to tweet while you're here - and feel free to submit questions that way as well before we get started I'd like to thank the Commonwealth Fund for making today's briefing possible and for their partnership and support so let's dive into the topic after a deliberative process lasting since the passage of the Medicare access and chip reauthorization Act in 2022 earlier in November CMS released its final rule pertaining to macros quality payment program and as we know efforts are well underway around the country to encourage a shift to value-based payment models for Medicare providers that mean while the Medicare Payment Advisory Commission medpac recently recommended a move away from the key component of Macra the merit-based incentive payment system towards a different approach to value-based payment and there are many nuances and complexities to the implementation of many of these measures so we're here today to examine the issues that are on the table as health care providers around the country work to understand and implement these these measures and as policymakers consider additional shifts to the way providers might be paid and what all this really means for improving health outcomes and quality and for health care costs so you're going to hear today from five really excellent speakers each of whom brings a different perspective to the discussion and we're really grateful to have them here today to shed some light on the discussion so joining us today and I'll just introduce them in order and speaking order Len nickels who is director of the Center for Health Policy Research and ethics at George Mason University Len was also appointed to the physician focused payment model technical advisory committee or PTAC which was created in the macro legislation and we'll hear more about that Len holds a PhD in economics from University of Illinois at urbana-champaign next OSHA prot Shenron era who is director of electronic and clinician electronic and clinician quality division at the Centers for Medicare and Medicaid Services and Gregory woods who is the director of the division of alternative payment model infrastructure at the CMS Innovation Center and they're gonna give a joint presentation about efforts at CMS and CMMI outcha holds a master master's in Health Sciences in Health Policy from Johns Hopkins University and Gregory holds a master's in public.


Is it legal to have an unregistered off-the-grid (no birth certificate) baby in the USA?
I was actually roommates with someone in College whose parents decided to have him “off-grid”. Let me just say this: Stop even entertaining the idea of having a baby off-grid. It really makes your child’s life unnecessarily hard and your kid will forever resent you for putting that pain on them.I’ll get into the details in a moment, but first let me address the question proposed above. Yes, technically speaking it is not a crime to have your baby off-the-grid in the U.S.A. However, a lot of details surrounding the event would be illegal. First of all, any licensed midwife or doctor is required by law to file a birth certificate or they actually risk losing their license and getting a misdemeanor. If you forced them or threatened them to not file the birth certificate that would make you a likely accomplice and would not go over well with the authorities.But let’s ignore that for a moment and just assume you know how to birth a child on your own and can do it in your basement without any professional medical physician there to oversee you (which would be the only way you could pull this off). In this case you wouldn’t get thrown in jail for failing to get a birth certificate and no crime would have been committed. However you just set up a very difficult life for your child.These are some of the things I was told from by my roommate who didn’t have a social security number until he was 20 years old.No, he could not get a (legal) jobQuite literally he didn’t qualify to get even a job at McDonalds. If you remember the last job you got no matter how prestigious or demeaning it was, you had to fill out a bunch of paperwork. Most of these forms require you to have a SSN (social security number) to properly fill them out. However the important one is the form labeled I-9. This form is required to be submitted by every employer after hiring a new employee. This form serves only one purpose, to determine that you are eligible to work in the United States. Your child (and my roommate) would not be able to complete this form which every employer must get filled out before starting employment with a new employee. Your child will not be able to get a job because of this.Yes, he can evade paying taxes.Okay, so this sounds like a perk I guess. But my roommate did not have to pay taxes. The government basically didn’t know he existed, so they never knew he was not paying. But then again he didn’t have a job. So would you rather have a job and pay some taxes or not ever be able to work except under the table for below minimum wage? Given that choice, taxes sound pretty awesome! Keep in mind that this also means your child is not eligible for any tax benefits or credits such as those that students get while going to college.No, You as the parent can not claim him as a dependent on your taxesYou’re already dealing with a child, wouldn’t it be great to get that child tax credit? Every year you'll basically be paying out of pocket for deciding not to get them a SSN.Yes, he can attend public school through 12th gradeHe would be able to attend school through high school without a social security number.No, he can not attend collegeWhile high school and lower education is okay, your child will never be able to attend collegeYes, he can go to the doctorThe doctor will still see your child and prhim his shots. However…No, he will not be covered under your family insurance (or qualify for Medicare/Medicaid)So you’ll need to plan on paying for all doctor appointments out of pocket.No, he can not travel abroad (even to Canada)You’d best hope none of your child’s friends decide to go to Cancun for spring break. Your child will not be eligible to leave the country or return to the US if he manages to leave (unless he plans to climb Trump’s wall)No, he will not be able to drive a carOkay, well nothing is stopping him from physically driving a car, but he would not be able to get a driver’s license and thus, can not LEGALLY drive. Hope he doesn’t get pulled over.No, he will not be able to voteOnce old enough he will not be able to register to vote.Yes, he can avoid the draftWell the good news is that like taxes, he can skirt the requirement to join the draft when he turns 18.No, he can’t get a loanThis means no credit cards, no car loan, no home, nothing. I’m sure plenty of people will claim these are all evil anyway, but these have powerful impacts on someone’s life. There might be times he needs it. (and when used properly none of these are bad things).No, he will not have a credit scoreThis goes with the above one, but he will not be able to work on this which affects your entire life/future. This also will disqualify him from renting most homes or apartments he is looking at.Basically your child will be treated as an illegal immigrant. Why put them through this when they are entitled to the benefits that the United States provides its citizens? There are people in other countries dying to get what your child is entitled to and you are (considering) denying your child those abilities? It just doesn’t make sense.Get them a SSN and if your child decides at 20 that he wants to live off-the-grid than he can burn his Social Security Card and go in the woods and hide from the government. But don’t be selfish enough to make that decision for them.My roommate resents his parents for not giving him a SSN. While all his friends in high school were driving, he couldn’t. While his friends go to Cancun for spring break, he had golden handcuffs in the U.S. and can’t leave. And worst of all he said was that while all his friends were earning money from jobs in high school, he couldn’t get a job.The job part was the hardest for him. He couldn’t leave the house or move out when he turned 18. He was stuck at home.Him working on getting a social security number was difficult and took him two years. He started when he turned 18 to get one once he realized he couldn’t go to college, he couldn’t get a job, he couldn’t rent an apartment, and thus will never really be able to be independent from his parents. It took two years and then at 20 he was able to get one and start working and going to school.He forever resented his parents. Don’t be those parents…
What steps must a licensed professional counselor take to accept insurance or medicaid/medicare?
It depends on your state, but typically, they want you to fill out the CAQH application. But each insurance can be very different in how they go about the process. Medicaid and Medicare are a bit different, but again, you will most likely be required to fill out the CAQH. I would ask your colleagues who they take (insurance) and why. I currently only accept two carriers - one national, and one local (but quite large). I do this for two reasons:1) Reimbursement rates are pretty decent with each (the local being superior) and2) Ease of filing - one has a clearinghouse that they prfor free to providers, and the other pays so well, I don't mind filling out the claims forms by hand!I have been in private practice since 2022. and I have only recently began taking insurance. My learning curve has been interesting, but I will say, both groups I chose have been excellent to work with, thus far. Hope this helps!
How does Medicare pay providers?
It depends on the provider at issue.Hospitals, for example, receive bundled payments via a prospective payment system or PPS. (Medicare employs PPSes in numerous care settings, but the inpatient hospital PPS is one of the more refined systems). For inpatient care, for example, Medicare payments are set using the Medicare Severity-Adjusted Diagnosis-Related Group system. In very brief terms, Medicare assesses how much it costs hospitals to prcare for a given diagnosis - say, a pneumonia hospitalization - then adjusts the resulting payment based on the severity of the patient’s condition and other complications, like age and comorbidities. The theory is that, on average, the PPS payments that a hospital receives will cover each patient’s care, and as an additional benefit, the bundled payment will princentives for hospitals to avoid providing more care simply to receive more payments.Doctors, however, are paid under Medicare’s physician fee schedule, or PFS. The PFS is a traditional fee-for-service system, where providing additional services means the doctor is paid more. As you might imagine, this is imperfect from policymakers• perspectives, but attempts to bundle payments for physicians have proven to be tremendously complicated.Medicare providers• payments are authorized by Congress and implemented by the federal government via regulations. The actual payments are typically made via electronic transfer and (I think) are made every two weeks. Medicare is among the most prompt of health care payers, but while that’s beneficial to providers, it’s also a bit of a downside when it comes to anti-fraud efforts.
Why don’t employers in Australia prinsurance to fill gaps of Medicare (Canada does that)?
Why don’t employers in Australia prinsurance to fill gaps of Medicare (Canada does that)?Prior to the 1980s there were companies in Oz that provided a range of Fringe Benefits such as gap insurance or full private health insurance. In fact, just after Medicare was introduced, the insurance company FAI had a policy for “gap” insurance, but that threatened “the scheduled fee” regime of the government and encouraged MDs to charge above the schedule fee. MDs can to this day charge above the schedule fee, and its upto the patient whether to change MDs to avoid the excess or not. In any case, the laws changed & insurance companies either had to prfull health insurance comparable to Medicare or none at all (they could prsupplementary cover for dental, chiro etc & other services not covered by Medibank).Anyway, prior to 1986 execs like me took full advantage of negotiating fringe benefits in lieu of salary to avoid (reduce) income tax (the top rate was 60% on each $ over x amount).To reduce income tax overall, the government introduced a Fringe Benefit Tax (FBT), that gross up the “net” (pocketed) benefit and taxed FBs at the top rate. That caused junior execs to be worse off but had no real inpact on senior execs. The admin overhead to report & collect FBTs was a pain for business, so many large businesses stopped offering FBs & initially grossed up salaries instead. Some companies continue offering FBs, but usually in the form of cars, private school fees, golf club fees etc. Depending on how FBs are structured they have tax advantages - an industry evolved ti design “salary forfeitures” in exchange for FBs to minimize (avoid) income tax (eg: granting of options or shares has major tax advantages). Like car leasing, some companies instead of direct provision have arrangements with health funds for “bulk rates” which are cheaper than the normal retail offerings. The major advantage over employer provided health cover, is the employee can take their health cover from employer to employer or change funds offering better rates or cover.Years ago I read how the USA ended up with its strange, inequitable system of employer sponsored health insurance. My memory is vague on the details, but as I remember it, after WW2 there were labour shortages in certain occupations, and employers came to offering sweeteners to attract people to them. Then came the McCarthy (there is a commie under every bed) purges of the 1950s , and that put the nail in the coffin of publicly subsidised health care.Before medicare, here in Australia we had non-profit mutual funds & benevolent societies that provided health insurance. Then USA carpetbaggers entered the market, which led to the Health funds demutalising & becoming for-profit organisations. Health costs began to rise because of the obvious monopolies, so Oz put the brakes on this exploitation and introduced Medicare which gave the same cover at a lower cost to the populace. Australians pay a contribution of 2% of net taxable income towards medicare costs (the rest comes from general revenue). There is no cost to low income households & pensioners. Persons earning excessive income (over $90k for singles, or $180k for households) pay a 1% surcharge or are obligated to take out private health cover (their free choice).In my families experience, it is a most excellent system if you are genuinely ill and needing medical assistance. You see the MD of your choice. Generally you see the specialists your MD refers you to, just as happens with private insurance. If stuck in hospital, you’ll generally be admitted to a ward with four beds in it (my preference). Sometimes when there is necessity you are put in a private room (most lonely if you aren’t sedated or high on medication). In a public hospital, like private health cover, you generally don’t get a choice of doctor etc but everything is free (private hospitals itemise everything and you are at the mercy of the health funds for partial remittances).
How can I claim the VAT amount for items purchased in the UK? Do I need to fill out any online forms or formalities to claim?
Easy to follow instructions can be found here Tax on shopping and servicesThe process works like this.Get a VAT 407 form from the retailer - they might ask for proof that you’re eligible, for example your passport.Show the goods, the completed form and your receipts to customs at the point when you leave the EU (this might not be in the UK).Customs will approve your form if everything is in order. You then take the approved form to get paid.The best place to get the form is from a retailer on the airport when leaving.
What is the purpose of government red tape?
"Red tape" refers to the information required in transactions with the government, or other institutions (for example, insurance companies).I understand the term comes from a time when all information flows were via paper, and papers relating to a particular transaction were held together in bundles by red ribbon, or "tape." Over time the term has come to mean the papers, or other media, involved in a transaction, although red tape isn't used any longer.When you pay your income tax, you don't simply write a check. You have to write down, or enter on an online form, information on what you earned, and on what deductions you claim, along with other information. Your employer provides a W2 form that shows how much you were paid in wages or salary. Your bank provides a form showing how much interest you earned on your savings account, or how much interest you paid on you home mortgage. All of this information, the Form 1040 that you fill out showing income and deduction, and backup information from your employer, bank, etc., are red tape. Another example is when you reach retirement age and have to fill out forms and prbackup documents to begin collecting Social Security and be eligible for Medicare.Red tape is generally considered a pain in the neck, and it is. However, the government employee doesn't know what you are entitled to, or what the government is entitled to, without information. Furthermore, months and years later government auditors and other reviewers can't see the basis for the action taken without the documentation that is red tape.While red tape is necessary, it is sometimes made unnecessarily difficult to deal with. The U. S. Federal government tries to make red tape less burdensome. The Office of Management and Budget (OMB) controls forms issued by agencies. OMB seeks to reduce duplication in information gathering by agencies, and requires agencies to ethe cost to citizens for filling out forms. IT makes data collection easier. Having said all of that, red tape is a pain, and there are always areas in which it can be improved.
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